If you’ve been diagnosed with prostate cancer, your doctors will try to figure out if it has spread, and if so, how far. This process is called staging.
Determining the stage of prostate cancer
The stage of a prostate cancer describes how much cancer is in the body. It’s one of the factors used to help determine how best to treat the cancer. Doctors also use a cancer’s stage when talking about survival statistics.
The stage is based on tests described in Tests to Diagnose and Stage Prostate Cancer, including the blood PSA level and prostate biopsy results, as well as imaging tests if they are done.
The AJCC TNM staging system
A staging system is a standard way for the cancer care team to describe how far a cancer has spread. The most widely used staging system for prostate cancer is the AJCC (American Joint Committee on Cancer) TNM system, which was most recently updated in 2018.
The TNM system for prostate cancer is based on 5 key pieces of information:
- The extent of the main (primary) tumor (T category)*
- Whether the cancer has spread to nearby lymph nodes (N category)
- Whether the cancer has spread (metastasized) to other parts of the body (M category)
- The PSA level at the time of diagnosis
- The Grade Group (based on the Gleason score), which is a measure of how likely the cancer is to grow and spread quickly. This is determined by the results of the prostate biopsy (or surgery).
*There are 2 types of T categories for prostate cancer:
- The clinical T category (written as cT) is your doctor’s best estimate of the extent of your cancer, based on the results of the physical exam (including a digital rectal exam) and prostate biopsy, and any imaging tests you have had.
- If you have surgery to remove your prostate, your doctors can also determine the pathological T category (written as pT). The pathological T is likely to be more accurate than the clinical T, as it is done by examining the entire prostate in the lab.
Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once the T, N, and M categories have been determined, this information is combined (along with the Grade Group and PSA level if they are available) in a process called stage grouping to get the overall stage of the cancer.
The main stages of prostate cancer range from I (1) through IV (4). Some stages are split further (IIA, IIB, IIC, etc.). As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means cancer has spread more. And within a stage, an earlier letter means a lower stage. Although each person’s cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way.
Stages of prostate cancer
AJCC Stage | Stage grouping | Stage description |
| I | cT1, N0, M0 Grade Group 1 (Gleason score 6 or less) PSA less than 10 | The doctor can’t feel the tumor or see it with an imaging test such as transrectal ultrasound. (It was either found during a transurethral resection of the prostate (TURP) or was diagnosed by needle biopsy done for a high PSA [cT1].) The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The Grade Group is 1, and the PSA level is less than 10. |
OR | ||
cT2a, N0, M0 Grade Group 1 (Gleason score 6 or less) PSA less than 10 | The tumor can be felt by digital rectal exam or seen with imaging, such as transrectal ultrasound, and is in one half or less of only one side (left or right) of the prostate [cT2a]. The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The Grade Group is 1, and the PSA level is less than 10. | |
OR | ||
pT2, N0, M0 Grade Group 1 (Gleason score 6 or less) PSA less than 10 | The prostate has been removed with surgery, and the tumor was still only in the prostate [pT2]. The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The Grade Group is 1, and the PSA level is less than 10. | |
| IIA | cT1, N0, M0 Grade Group 1 (Gleason score 6 or less) PSA at least 10 but less than 20 | The doctor can’t feel the tumor or see it with imaging such as transrectal ultrasound. (It was either found during a transurethral resection of the prostate (TURP) or was diagnosed by needle biopsy done for a high PSA level [cT1].) The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The Grade Group is 1. The PSA level is at least 10 but less than 20. |
OR | ||
cT2a or pT2, N0, M0 Grade Group 1 (Gleason score 6 or less) PSA at least 10 but less than 20 | The tumor can be felt by digital rectal exam or seen with imaging such as transrectal ultrasound and is in one half or less of only one side (left or right) of the prostate [cT2a]. OR the prostate has been removed with surgery, and the tumor was still only in the prostate [pT2]. The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The Grade Group is 1. The PSA level is at least 10 but less than 20. | |
OR | ||
cT2b or cT2c, N0, M0 Grade Group 1 (Gleason score 6 or less) PSA less than 20 | The tumor can be felt by digital rectal exam or seen with imaging such as transrectal ultrasound. It is in more than half of one side of the prostate [cT2b] or it is in both sides of the prostate [cT2c]. The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The Grade Group is 1. The PSA level is less than 20. | |
| IIB | T1 or T2, N0, M0 Grade Group 2 (Gleason score 3+4=7) PSA less than 20 | The cancer has not yet spread outside the prostate. It might (or might not) be felt by digital rectal exam or seen with imaging such as transrectal ultrasound [T1 or T2]. The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The Grade Group is 2. The PSA level is less than 20. |
| IIC | T1 or T2, N0, M0 Grade Group 3 or 4 (Gleason score 4+3=7 or 8) PSA less than 20 | The cancer has not yet spread outside the prostate. It might (or might not) be felt by digital rectal exam or seen with imaging such as transrectal ultrasound [T1 or T2]. The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The Grade Group is 3 or 4. The PSA level is less than 20. |
| IIIA | T1 or T2, N0, M0 Grade Group 1 to 4 (Gleason score 8 or less) PSA at least 20 | The cancer has not yet spread outside the prostate. It might (or might not) be felt by digital rectal exam or seen with imaging such as transrectal ultrasound [T1 or T2]. The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The Grade Group is 1 to 4. The PSA level is at least 20. |
| IIIB | T3 or T4, N0, M0 Grade Group 1 to 4 (Gleason score 8 or less) Any PSA | The cancer has grown outside the prostate and might have spread to the seminal vesicles [T3], or it has spread into other tissues next to the prostate, such as the urethral sphincter (muscle that helps control urination), rectum, bladder, and/or the wall of the pelvis [T4]. It has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The Grade Group is 1 to 4, and the PSA can be any value. |
| IIIC | Any T, N0, M0 Grade Group 5 (Gleason score 9 or 10) Any PSA | The cancer might or might not be growing outside the prostate and into nearby tissues [any T]. It has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The Grade Group is 5. The PSA can be any value. |
| IVA | Any T, N1, M0 Any Grade Group Any PSA | The tumor might or might not be growing into tissues near the prostate [any T]. The cancer has spread to nearby lymph nodes [N1] but has not spread elsewhere in the body [M0]. The Grade Group can be any value, and the PSA can be any value. |
| IVB | Any T, any N, M1 Any Grade Group Any PSA | The cancer might or might not be growing into tissues near the prostate [any T] and might or might not have spread to nearby lymph nodes [any N]. It has spread to other parts of the body, such as distant lymph nodes, bones, or other organs [M1]. The Grade Group can be any value, and the PSA can be any value. |
Prostate cancer staging can be complex. If you have any questions about your stage, ask someone on your cancer care team to explain it to you in a way you understand.
While the stage of a prostate cancer can help give an idea of how serious the cancer is likely to be (and which treatments might be best), doctors are now looking for other ways to tell how likely a prostate cancer is to grow and spread, which might also help determine a man’s best treatment options.
For example, if prostate cancer hasn’t spread, doctors will often assign it a risk group to help determine the best treatment options. Newer types of lab tests can also be used to help determine if the cancer needs to be treated right away, as well as which types of treatment might be good options. To learn more, see Risk Groups and Lab Tests to Help Determine Risk from Localized Prostate Cancer.
- Written by
- References
The American Cancer Society medical and editorial content team
Our team is made up of doctors andoncology certified nurses with deep knowledge of cancer care as well as editors and translators with extensive experience in medical writing.
American Joint Committee on Cancer. Prostate. In: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017: 715-725.
Klein EA. Prostate cancer: Risk stratification and choice of initial treatment. UpToDate. 2023. Accessed at https://www.uptodate.com/contents/localized-prostate-cancer-risk-stratification-and-choice-of-initial-treatment on July 26, 2023.
National Comprehensive Cancer Network (NCCN). Practice Guidelines in Oncology: Prostate Cancer. Version 2.2023. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf on July 26, 2023.
Taplin ME, Smith JA. Initial staging and evaluation of males with newly diagnosed prostate cancer. UpToDate. 2023. Accessed at https://www.uptodate.com/contents/initial-staging-and-evaluation-of-males-with-newly-diagnosed-prostate-cancer on July 26, 2023.
Last Revised: November 22, 2023
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